Healthcare Provider Details

I. General information

NPI: 1982933727
Provider Name (Legal Business Name): KRISTINA JILL WILLIAMS DNP, ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MERCY WAY STE 440
JOPLIN MO
64804-4524
US

IV. Provider business mailing address

100 MERCY WAY STE 440
JOPLIN MO
64804-4524
US

V. Phone/Fax

Practice location:
  • Phone: 417-781-4404
  • Fax: 417-781-5845
Mailing address:
  • Phone: 417-781-4404
  • Fax: 417-781-5845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2014017985
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: